Endocrine Abstracts

JOINT32693

Introduction: Adrenal hemorrhage is a rare condition in the neonatal period (0.2%-0.55%) and rarely causes adrenal insufficiency. Here, we present 3 cases that developed adrenal insufficiency in the neonatal period due to different reasons and then had different clinical courses.

Case 1: The patient was admitted to the neonatal intensive care unit due to urinary tract infection(UTI). During the investigation of the etiology of UTI, an ultrasound scan was performed to observe adrenal hemorrhage measuring 33x24mm on the right and 40x22mm on the left in both adrenal gland locations. After the 250 mg ACTH stimulation test, peak cortisol was determined 12.6 mg/dl and 6 mg/m²/day hydrocortisone treatment was started. The patient was born term and 3800gr, had no birth trauma. The patient continued to use hydrocortisone for 6 months. In the 7th month 1 mg ACTH stimulation test, the peak cortisol response was observed as 16.2 and the medication was stopped. He has been followed up without medication for 6 years.

Case 2: A male patient born term, 4000gr and 52 cm, had a 43x16x33mm hemorrhage area in the right adrenal gland and a 35x20x33mm hemorrhage area in the left adrenal gland during the abdominal USG performed due to traumatic birth. The patient’s cortisol was 11 mg/dl and ACTH was 202, and due to insufficient cortisol response to the standard dose ACTH stimulation test, hydrocortisone treatment was started. Hydrocortisone treatment is being continued at 12 mg/m²/day.

Case 3: A female patient who was examined for sepsis as a newborn had a 23x13mm hematoma on the right adrenal gland and a 18x15mm hematoma on the left. She was born at term, vaginally, and weighed 3800grams. There was no hypoglycemia in the patient, but blood sodium was measured as 132 mg/dl and potassium as 6 mg/dl. When a standard dose ACTH stimulation test was performed, peak cortisol levels were determined as 12.6 mg/dl. The patient was started on 54 mg/m²/day hydrocortisone treatment. When she was 15 months old, the treatment was discontinued because peak cortisol was sufficient in a standard dose ACTH stimulation test.

Discussion: Adrenal hemorrhage may be caused by different clinical reasons and may progress with different clinics. Our study has shown that the clinical course of adrenal insufficiency secondary to adrenal hemorrhage may be very variable, and it is important that the clinical follow-up of these patients must be personalized and frequent.